Friday, April 24, 2015

MI Mental Health System, Including Services to DD, Severely Impacted by Funding Cuts

At the last Washtenaw Community Health Organization Board meeting on 4/22/15, a packet of news articles about statewide problems with budget deficits and service cuts was distributed. These articles date from January 2014 to the present. Washtenaw County is its own special case, as the WCHO goes through a change from a "Community Health Organization" to a "Community Mental Health Agency" while also dealing with a $3.8million budget deficit. (More on Washtenaw County later). 

The problems with state funding of Community Mental Health (CMH) services, including services to the developmentally disabled population, are complex. I am no expert on Mental health funding and it is likely that my take on it is not entirely correct, but this is what I think has happened based on news articles:
  • Michigan's Medicaid expansion (Healthy Michigan) began enrolling participants in April of 2014; 
  • The State expected a large influx of federal funds to pay for health care to eligible citizens through Medicaid expansion and on that basis made large cuts to  state Medicaid funding and to non-Medicaid General Funds that local agencies use to fill in the gaps for people not in the Medicaid system. 
  • The State also adjusted payments to counties to make funding more evenly consistent throughout the state, resulting in some counties receiving more Medicaid funding and some less than before. 
  • Large increases in people insured by Healthy Michigan and decreases in numbers insured by "regular" Medicaid have resulted in less funding for regular Medicaid mental health services, at the same time that the numbers served by the CMH system have increased. (Apparently, the two Medicaid systems are funded separately). 
  • The Governor's desire to use the increased Medicaid funding from the federal government as savings for future costs to the State, has made less money available to pay for current services. 
  • The legislature's expectation of increased federal funding to cover current and future costs was overly optimistic.
News Articles on State-wide Stresses on the Michigan CMH system
"Cuts likely necessary for Oakland’s Mental Health Authority, with $11M deficit", 4/7/15: $11million deficit...cuts to providers, programs, and layoffs likely…$14million reduction in Medicaid dollars from the state….some providers could go out of business…worst-case scenario - more cuts in 2016 fiscal year.

Kent County’s Community Mental Health authority Network 180 press release [no link available], 4/8/15: Board votes to implement agency-wide cuts…salary cuts…”adults with DD will see a dramatic reduction in daily support and services immediately”…new lower Medicaid rates in West Michigan to increase rates in other parts of the state…affected by unexpected drop in traditional Medicaid enrollment with introduction of Healthy Michigan (Medicaid expansion).

Cuts threaten services for Oakland Co. disabled” 9/24/14: 2014-15 budget includes $20million in state aid cuts to general fund and $14million in cuts from Medicaid…Changes under the Affordable Health Care Act - “Michigan opened Medicaid to nearly 500,000 additional residents and moved their health care costs—including mental health care costs —off the state’s books and on to federal rolls”…..In anticipation of savings, state trimmed $75million from mental health spending for 2014-15 fiscal year…some cuts offset by federal dollars…number of people served by Michigan’s CMH system climbed from 184,708 in 2004 to 248,189 last year [2013]…

Funding cuts send hundreds of mentally ill onto Detroit’s streets 5/1/14: Detroit’s longtime round-the-clock homeless shelter turns out hundreds of people…no place to go…when state lawmakers passed Medicaid expansion, an infusion of federal funds was expected to make up for cuts based on anticipated savings…general fund dollars also cut…CEO of Detroit CMH on state plan: “It’s like, next month you need to pay the mortgage, and the state says, ‘Well your grandmother may die in the next six months and leave you the money.'”

Local mental health programs face cutsfrom Northern Lakes Community Mental Health Blog, 4/3/14 : “Community mental health groups across the state began to lose roughly 54 percent of their state-funded general purpose money on Tuesday, the same day enrollment in the Healthy Michigan Plan opened.” [General fund dollars, as opposed to Medicaid dollars serve people who do not qualify for Medicaid but nevertheless have needs served by the mental health system such as children, people on Medicare, and many people who are mentally ill.]

Adult Foster Care Aid May be at Risk, Advocates Say” 5/30/14 from Kaiser Health News/Detroit News: “As part of major changes associated with the health care overhaul, also known as Obamacare, Michigan opened Medicaid to nearly 500,000 additional residents. That moves their health care costs — including mental health — off the state’s books and onto the federal government’s.”…state trimmed mental health spending for the current fiscal year [2013-14]by $75 million, Snyder wants to trim more…”The state’s not going to save as much as they think they are.”…Gov. wants most of the annual savings to cover future Medicaid costs…

Michigan community mental health centers turning away patients, blame ‘flaw’ in Medicaid expansion” from, 4/22/14 :  “Local mental health officials say Gov. Rick Snyder's administration overestimated the savings from Healthy Michigan [Michigan's Medicaid expansion], resulting in a funding shortfall for CMH boards across the state.”…”While overall funding has increased, CMH programs are still left with funding gaps because the Healthy Michigan dollars can't be used to fund services for those who don't have Healthy Michigan coverage.”…”Vizena [from the association of CMH Boards] said he had hoped the state would have done a better job to make sure there wasn't a time gap between losing the general fund money and getting an influx of money through new Healthy Michigan enrollees”.

Macomb, St. Clair County CMH cut services” 4/29/14: “Macomb County CMH is cutting services to about 1,350 people. St. Clair County Community Mental Health is cutting services to approximately 300 people. Sanilac County CMH is cutting services to about 90 people.”…St. Clair County uses the general fund money to cover people on Medicare...Medicare covers only about 80 percent of the cost of mental health services, the rest of which the CMH covers with general fund monies….general funds help cover “spend downs”, deductibles before insurance kicks in….

Proposed mental health funding cuts could hurt Jackson’s uninsured, mentally ill population” from, 1/6/14: Maribeth Leonard, the CEO of Jackson County's mental health agency LifeWays - legislators are assuming too much under the expansion…In 2013, LifeWays served 2,780 patients who were uninsured or not covered under Medicaid with general fund dollars…

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